Australia's public health achievements and population health gains
Authors: Michelle Dickson, Cheryl Jones, Terry Slevin, J Jaime Miranda
Journal: The Lancet Public Health (2023)

Australia belongs to a selected group of countries where the impacts of the COVID-19 pandemic, at least in terms of mortality and excess deaths, were minimal compared with much of the rest of the world.1Msemburi W Karlinsky A Knutson V Aleshin-Guendel S Chatterji S Wakefield J The WHO estimates of excess mortality associated with the COVID-19 pandemic.Nature. 2023; 613: 130-137Crossref PubMed Scopus (59) Google Scholar The capacity of the health system alongside other government structures to confront such a major acute global shock was notorious. Yet, this high performance is not static and requires constant adaptation to ongoing and new challenges to maintain healthy populations. Understanding the burden of disease in Australia is essential to revisit what works, what needs to be done in the future, and which adjustments are needed. This understanding is particularly timely as Australia is poised to establish its first national Centre for Disease Control to better coordinate public health responses across its federated government.2Australian Government Department of Health and Aged CareAustralian Centre for Disease Control, Australian Government Department of Health and Aged Care.https://www.health.gov.au/our-work/Australian-CDCDate: July 11, 2023Date accessed: July 11, 2023Google Scholar, 3Marais B Basseal J Gilbert L Sorrell T How should an Australian centre for disease control prepare us for the next pandemic. The University of Sydney, June 14, 2022https://www.sydney.edu.au/news-opinion/news/2022/06/14/-how-should-an-australian-centre-for-disease-control-prepare-us-.htmlDate accessed: July 11, 2023Google Scholar The study from Shariful Islam and colleagues4GBD 2019 Australia CollaboratorsThe burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Public Health. 2023; 8: e585-e599Summary Full Text Full Text PDF Google Scholar provides an assessment of several metrics of disease burden using harmonised data from the 2019 Global Burden of Disease study of almost three decades, dating back to 1990. Some findings are especially noteworthy. First, the remarkable increase of almost 6 years in life expectancy, up to 2019, in a context in which other high-income countries were already experiencing reversals before the pandemic.5Jasilionis D Reversals in life expectancy in high income countries?.BMJ. 2018; 362k3399 PubMed Google Scholar Even in a post-pandemic world, with worldwide declines in life expectancy being reported from 2019 to 2021, Australia is listed among the exception.6Heuveline P Global and national declines in life expectancy: an end-of-2021 assessment.Popul Dev Rev. 2022; 48: 31-50Crossref PubMed Scopus (10) Google Scholar Despite this, Australia as a high-income country still has major health and other social, educational, and human capital inequities, often experienced by Aboriginal and Torres Strait Islander Australians.7Australian Indigeneous HealthInfoNetOverview of Aboriginal and Torres Strait Islander health status 2022. Australian Indigenous HealthInfoNet, Perth2023Google Scholar Second, non-communicable diseases remain the major cause of mortality in Australia, accounting for 91% of all deaths. This predominance has not changed over the study period, and successes can also be observed as age-standardised death rates decreased by more than 50% for three causes, ischaemic heart disease, stroke, and road injuries. These insights point towards the need to sustain priority responses to counter these major groups of conditions and signal adaptations to the necessary responses, be it through reinforcements of existing policies or incorporating new ones to address areas for which no major changes were observed. For example, low back pain and depressive disorders remain the top two causes of years of life lived with disability, over the 30 years of the study. Lastly, the comparison of Australia with 14 other countries with a similar Socio-demographic Index point to areas of concern. The gains made in age-standardised mortality were not mirrored in improvements in morbidity. For example, in 2019, Australia's rankings for depressive disorders, falls, drug-use disorders, and anxiety disorders are worse than most comparator countries. Burden of disease analyses are important tools to track progress and trajectories and should be used in conjunction with other inputs in policy decision-making. Diseases are a factor of time and place, and the absence of area-based insights in Islam and colleagues' analysis is a major limitation. Group characteristics are also essential. Other than the disaggregation of data by sex, which is important, Australia cannot and should not embark on further prioritisation areas for action without inputs from the Aboriginal and Torres Strait Islander Australian population. Australia has a world-class health-care and public health system that has been conducive to major population gains, at least in life expectancy. Yet, work remains to be done to marry such gains with strategies and policies to prevent or reduce disease burden during the entire lifecourse, and to reduce inequalities. This will be essential to sustain this world-class health system and to promote healthier societies. Australia is a public health exemplar to the world and offers a unique ecosystem for knowledge sharing. Public health has an intrinsic social contract which brings responsibilities both within and beyond Australia. Internally, this social contract ought to bring the health of all front and centre, and this will not be achieved if Aboriginal and Torres Strait Islander Australians remain marginalised and invisible from metrics ued for policy making and monitoring, as well as invisible in the process of determining what metrics are used to guide policy. Australia's achievements on various fronts in public health, from the acknowledgement of the wider complexities of early prevention efforts as in the case of childhood obesity,8Zhu W Marchant R Morris RW Baur LA Simpson SJ Cripps S Bayesian network modelling to identify on-ramps to childhood obesity.BMC Med. 2023; 21: 105Crossref PubMed Scopus (0) Google Scholar to community-driven culturally appropriate responses to the COVID-19 pandemic,9Crooks K Casey D Ward JS First Nations peoples leading the way in COVID-19 pandemic planning, response and management.Med J Aust. 2020; 213: 151-152Crossref PubMed Scopus (61) Google Scholar must align with the responsibility to strive for greater improvements, especially for those experiencing most disadvantage. In sharing Australia's public health experience with the international community, Australia demonstrates knowledge building and knowledge transfer, an ethos that is essential to the transformations required to achieve the Sustainable Development Goals.10Global Sustainable Development Report 2023. United Nations.https://sdgs.un.org/gsdr/gsdr2023Date accessed: July 11, 2023Google Scholar We declare no competing interests. The burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Full-Text PDF Open Access